Talk to your practice management system or billing system vendor to determine your practice’s readiness to send HIPAA-complaint claims to payers, including Medicare, Medicaid and all commercial health plans with which you have a contract. 

Consult the Practice Management System Directory for HIPAA Electronic Data Interchange at http://www.hipaa.org/pmsdirectory for contact information for your vendor.  Look for information there about the readiness of your practice management and billing system vendor to conduct business using the new HIPAA-standard transactions. 

Reject vendor statements such as “Don’t worry, we’re HIPAA compliant” as a response to your queries. 

List each payer or health plan to which you will send electronic claims.  This is important because each plan may implement the new standards in a slightly different manner, so “generic testing” of the transactions at the vendor or clearinghouse level is not enough. 

Request that your vendor immediately engage in end-to-end testing (from your office all the way to the health plan’s computer system) of these new HIPAA-standard transactions with each payer or health plan. 

Note: Know your HIPAA rights!  If your practice has done its part to assure that the claim information is formatted according to the new HIPAA standards, the health plans should not reject or delay your claim on the basis of format or content errors.  If any vendors do not agree to begin testing your claims, report the difficulty to the CMS hotline (click here) at  documenting your own compliance efforts. (Such documentation could be a mitigating factor when CMS later considers enforcement actions against non-compliant practices.) Locate another practice management system vendor if you’re uncomfortable with your vendor’s answers or testing commitment.

Plan now for disruptions in cash flow this fall by anticipating a 10 percent to 20 percent increase in rejected or delayed claims during the fourth quarter of 2003.  Put aside additional savings and cash reserves, put off new expenditures during this period and be prepared to get a commercial loan if necessary.